AI Article Synopsis
- The study investigates the impact of delayed diagnosis on patients with human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC), focusing on those diagnosed more than 12 months after symptom onset.
- Findings reveal that patients with a delayed diagnosis tend to present with more advanced disease stages, yet their long-term survival rates remain relatively high and comparable to those diagnosed earlier.
- Despite the increased disease burden at presentation, the study concludes that oncologic outcomes for delayed diagnosis patients are favorable, suggesting that treatment should not be postponed based solely on diagnosis timing.
Article Abstract
Objective: Diagnostic delay in human papillomavirus-associated oropharynx squamous cell carcinoma (HPV(+)OPSCC) is common due to nonspecific symptoms. We aim to describe the disease burden and oncologic outcomes of patients with HPV(+)OPSCC diagnosed >12 months after symptom onset.
Study Design: This is a retrospective cohort study of HPV(+)OPSCC patients receiving intent-to-cure treatment (including surgery ± adjuvant therapy or primary chemoradiation).
Setting: 2006-2016, tertiary care center.
Methods: Tumor stage was compared between patients with and without delayed diagnosis using χ tests. Kaplan-Meier survival analysis with univariate and multivariable Cox regressions were used to determine the effect of diagnostic delay on oncologic outcomes.
Results: In total, 664 patients were included. Compared to patients diagnosed <12 months from symptom onset (n = 601), those diagnosed at >12 months (n = 63) were more likely to have T4 disease and higher overall American Joint Committee on Cancer (AJCC) clinical stage at presentation ( < .01 for both). At 5 years, rates of overall survival, cancer-specific survival, progression-free survival, and distant metastases-free survival in the delayed diagnosis cohort were 80%, 90%, 80%, and 89%, respectively. A >12-month delay in diagnosis did not significantly impact overall survival (adjusted hazard ratio [aHR], 1.16; 95% CI, 0.58-2.31), cancer-specific survival (aHR, 0.83; 95% CI, 0.29-2.39), progression-free survival (aHR, 1.15; 95% CI, 0.56-2.37), or distant metastases-free survival (aHR, 1.00; 95% CI, 0.42-2.40) after adjusting for age, sex, and clinical AJCC stage ( > .05 for all).
Conclusions: Delayed diagnosis of HPV(+)OPSCC is associated with greater burden of disease at presentation, but oncologic outcomes remain favorable across treatment modalities. When appropriate, intent-to-cure therapy should be pursued despite diagnostic delay.
Level Of Evidence: Level III.
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| http://dx.doi.org/10.1177/01945998211000426 | DOI Listing |
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